Knowledge Center: Nasal Polyps

Monday, March 7, 2011

Nasal Polyps

Nasal polyps are common, noncancerous, teardrop-shaped growths that form in the nose or sinuses, usually around the area where the sinuses open into the nasal cavity. Mature nasal polyps look like seedless, peeled grapes.

Often associated with allergies or asthma, nasal polyps may cause no symptoms, especially if they're small, and require no treatment. But larger nasal polyps can block normal drainage from the sinuses. When too much mucus accumulates in the sinuses, it can become infected, which accounts for the thick, discolored drainage in the nose and down the throat that affects many people with nasal polyps.

Nasal polyps shouldn't be confused with the polyps that form in the colon or bladder. Unlike these types of polyps, they're rarely malignant. Usually, they're thought to result from chronic inflammation or a family tendency to develop nasal polyps.

Nor should nasal polyps be confused with swollen turbinates, which are the normal tissue that lines the side of the nose. Unlike swollen turbinates, they're not painful to the touch.

In most cases, nasal polyps respond to treatment with medications or surgery. Because they can recur after successful treatment, however, continued medical therapy is often necessary.

Symptoms of Nasal Polyps

Symptoms of nasal polyps include:

nasal obstruction
nasal congestion
sneezing
postnasal drip
runny nose
facial pain
reduced ability to smell (hyposmia)
loss of smell (anosmia)
loss of taste
itching around the eyes
chronic infections

Most people with nasal polyps have runny nose, sneezing, and postnasal drip; about 75% have a decreased sense of smell. Many people also develop asthmatic symptoms such as wheezing, sinus infections, and sensitivity to fumes, odors, dusts, and chemicals. Less commonly, people with nasal polyps also have a severe allergy to aspirin and reaction to yellow dyes.

If you have nasal polyps, you have an increased risk of chronic sinusitis. When nasal polyps become particularly large, they can push the nasal bones apart and broaden the nasal bridge, which can adversely affect appearance and self-esteem.

If you have severe allergy to aspirin or yellow dyes, you should consult with your doctor for evaluation of nasal polyps. In people with a combination of aspirin allergy, yellow dye sensitivity, and nasal polyps, allergic reaction is potentially life threatening.

Risk Factors for Nasal Polyps

Nasal polyps can affect people of any age, but they're most common in adults over age 40, and are twice as likely to affect men as women. They rarely affect children under age 10. When young children develop nasal polyps, cystic fibrosis should be considered as a possible diagnosis.

Although nasal polyps are associated with allergic rhinitis, asthma, aspirin allergy, sinus infections, acute and chronic infections, a foreign body in the nose, and cystic fibrosis, many times the cause is unknown. Sometimes, the formation of nasal polyps precedes the development of asthma or sinusitis.

Some researchers theorize that symptoms of allergies -- including runny nose, sneezing, and itching -- predispose people to develop nasal polyps. Other researchers theorize that sinus infections -- which cause tissue swelling and diminished drainage -- lead to the formation of nasal polyps. But the allergic connection is controversial. Some research suggests that nasal polyps may develop in nearly one-third of patients with asthma but only in about 2% of patients who have seasonal allergies with no diagnosis of asthma.

Medical Treatments for Nasal Polyps

If you suspect that you have nasal polyps, your doctor can usually diagnose them with a nasal endoscope, a tool with a magnifying lens or camera that provides a detailed view of your nose and sinuses. In some cases, your doctor may order additional tests or perform a biopsy of the polyp to ensure that it's not cancerous.

The first-line treatment for nasal polyps is a nasal corticosteroid spray. In many cases, such treatment can shrink or even eliminate nasal polyps. In other cases, a one-week tapered course of oral corticosteroids such as prednisone may be necessary.

Unfortunately, nasal polyps tend to recur if the underlying irritation, allergy, or infection isn't adequately controlled. So it may be necessary to continue using a corticosteroid spray to prevent the nasal polyps from returning and undergo periodic medical examinations with a nasal endoscope.

In general, medications such as antihistamines and decongestants are of minimal value in managing nasal polyps. In some cases, however, your doctor may order antihistamines to help control allergies, or a course of antibiotics to control an underlying infection before initiating the use of corticosteroid therapy.

Surgical Treatments for Nasal Polyps

Sometimes, nasal polyps are so large and obstructive that corticosteroid nasal sprays are ineffective. In such cases, surgery can be an effective option.

Surgical procedures are usually performed endoscopically, with a small nasal telescope that removes nasal polyps while preserving normal tissue. Most often, these procedures are performed at an ambulatory surgery center on an outpatient basis, where you can go home the same day as the surgery.

Although surgery is associated with significant improvement in most patients after 18 months, it may be less effective in patients who have nasal polyps and asthma or in patients who have nasal polyps, asthma, and aspirin sensitivity. But ongoing management with medication can help such patients achieve better asthma control and sense of smell while relieving breathing difficulties and facial pressure.

WebMD Medical Reference